A Bogus Cancer Statistic

Summary

In a new radio ad, Rudy Giuliani falsely claims that under England’s “socialized medicine” system only 44 percent of men with prostate cancer survive.

We tracked down the source of that number, which turns out to be the result of bad math by a Giuliani campaign adviser, who admits to us that his figure isn’t “technically” a survival rate at all. Furthermore, the co-author of the study on which Giuliani’s man based his calculations tells us his work is being misused, and that the 44 percent figure is both wrong and “misleading.” A spokesperson for the lead author also calls the figures “incorrect survival statistics.”

It’s true that official survival rates for prostate cancer are higher in the U.S. than in England, but the difference is not nearly as high as Giuliani claims. And even so, the higher survival rates in the U.S. may simply reflect more aggressive diagnosing of non-lethal cancers, according to the American Cancer Society.

Actually, men with prostate cancer are more likely to die sooner if they don’t have health insurance, according to a recent study published in one of the American Medical Association’s journals. Giuliani doesn’t mention that.

Analysis

Rudy Giuliani’s latest radio ad, which began airing in New Hampshire this week, draws a stark picture for anyone diagnosed with prostate cancer in England. “I had prostate cancer, five, six years ago,” the Republican presidential candidate says in the ad. “My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.”

Giuliani Radio Ad:‘Chances’

Giuliani: I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82%. My chances of surviving prostate cancer in England, only 44% under socialized medicine.
You and I should be making the decisions about what kind of health care we get with our doctors, not with a government bureaucrat. What we need to do is to give people a $15,000 deduction for a family, a $7500 deduction for an individual so they can go out and by their own health insurance.
If we do that, and we end up with a market of 50, 60 million Americans buying their own health insurance, without a mandate, the cost of health insurance will come down and the quality will come up.
Government has never been able to reduce costs. Government never increases quality.
We have the best health care system in the world. We just have to make it better.Announcer: Rudy Giuliani. Leadership. Principle. Results.Giuliani: I’m Rudy Giuliani and I approved this message.Announcer: Paid for by Rudy Giuliani Presidential Committee Incorporated. Visit joinrudy2008.com

Giuliani is wrong about that. Fortunately for the English, their chances of surviving prostate cancer are far better than Giuliani claims: The actual five-year survival rate is 74.4 percent, according to the United Kingdom’s Office of National Statistics. Even those in the U.S. have a better chance than what Giuliani states: The five-year survival rate is 98.4 percent in this country, according to the National Cancer Institute. (Furthermore, Milton Eisner, a statistician with the SEER program of NCI, which compiles these numbers, warns that the two countries’ statistics are “probably not comparable because they’re not done on the same scale.”)

Giuliani got his figures from a campaign adviser whose methods would make scientists and statistics professors cringe. Indeed, one of the authors of the report cited by the adviser says the figures in the ad are “misleading” and the math employed is “absolutely not” a legitimate way to calculate survival rates.

A Tale of Bad Math

Giuliani pulled these stats on prostate cancer from an opinion piece in this summer’s issue of City Journal, a publication of the conservative Manhattan Institute think tank. Giuliani spokeswoman Maria Comella says the former mayor saw the statistics himself and first cited them in a campaign stop. The article, titled “The Ugly Truth About Canadian Health Care,” was written by Dr. David Gratzer, a physician, senior fellow at the institute and a health care adviser to Giuliani. Gratzer states, without attribution: “The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England—a striking variation.”

What we find truly striking is Gratzer’s lack of thoroughness in checking his facts. His source, he says, is a 2000 report for the Commonwealth Fund by Gerard F. Anderson and Peter S. Hussey, of Johns Hopkins. When we checked with Hussey, now with the RAND Corp., he said Gratzer made inappropriate use of his report and was simply wrong.

The report, titled “Multinational Comparisons of Health Systems Data,” used data from the Organization for Economic Co-operation and Development (OECD) to compare health care indicators in several countries. It included a chart showing that for every 100,000 men in the United Kingdom (not just England) during the single year 1997, 49 were diagnosed with prostate cancer and 28 died. Gratzer says he looked at the number who died over the people who were diagnosed. Specifically, he calculated, incorrectly, that 21 had survived, and calculated that number as a percentage of those diagnosed. His math was off; that equation actually produces a “rate” of 43 percent, not 44. (He also took figures that applied to the U.K. and said they were only about England.) But either way, such back-of-the-envelope calculations don’t produce anything that public health officials recognize as a “survival rate,” which is usually given as the portion of patients who are still living five years after they are diagnosed.

“In fact, the five-year survival data cited in the City Journal article do not come from The Commonwealth Fund report, and cannot be calculated from that report,” reads a statement by the Commonwealth Fund sent to us at lead author Anderson’s request. “Five-year survival rates cannot be calculated from incidence and mortality rates, as any good epidemiologist knows.”

Hussey says of Giuliani’s figure: “It’s misleading, because to calculate a survival rate you need to track a population who get the disease.” He adds, “What you’re looking at here [in his report] is two different populations. One who is being diagnosed with the disease, and another who has died from the disease.” To calculate a valid five-year survival rate, those who were diagnosed with prostate cancer in 1997 would need to be followed to figure how many would live until 2002.

Gratzer, when we confronted him with this, conceded that his 44 percent figure “technically wasn’t a survival rate” – even though that’s what he called it in his article. He now calls his figure “a very crude indicator” and claims it “does give you an indication of what’s going on.” We disagree, as do other public health experts we consulted. The 44 percent figure is better described as a miscalculation based on decade-old data.

Hussey says the math that was performed on data in his report produces a number that is meaningless. “As somebody who’s trying to present facts I’m just disappointed that they were used in that way,” he says.

We can relate.

A ‘Misleading’ Comparison

Official figures do show a discrepancy between survival rates for prostate cancer in the U.S. and England. The U.S. five-year survival rate is actually 98.4 percent, according to the National Cancer Institute. The rate in England is 74.4 percent, as we noted earlier. But do these figures support Giuliani’s argument that “socialized medicine” can be lethal? Even using these figures, that’s not so clear.

For one thing, according to the American Cancer Society, many more men are screened for prostate cancer in the U.S. than in Britain. This leads to more cases being diagnosed. And many who have prostate cancer live for years, without treatment, whether they are diagnosed or not. Thus, a higher number of diagnoses leads to a higher official survival rate. But this tells us nothing about the quality of treatment available to those who have the disease. A spokesman for the ACS told us that comparing rates in the two countries is “misleading.”

On top of that, Eisner, with the National Cancer Institute, told us we would need to find numbers that are standardized to a world standard, not just compare rates given by the two countries’ government agencies. He referred us to Cancer Mondial, a Web site of the International Agency for Research on Cancer, which maintains databases of such standardized numbers. We were not able to find prostate cancer survival rates for all of the U.S. and all of England (the data is broken down into smaller regions). The best figures we could find were comparable mortality rates in an IARC/World Health Organization database. For 2002, those rates (per 100,000 men) were 15.6 and 12.0, in the U.K. and the U.S., respectively.

Getting it Backward

Besides using a false statistic, Giuliani implies the health plans put forth by the Democratic candidates are the same as the government-run, “socialized medicine” system in England. That’s simply false.

British health care is universal, overwhelmingly provided through the publicly funded National Health Service; only 12 percent of the population has private insurance, according to Gerard Anderson’s 2006 report on multinational health systems. The leading Democratic candidates’ plans include expanding government-offered insurance but they also allow people to keep whatever insurance they have now. Barack Obama’s plan mandates coverage for children, but not adults. The only Democratic candidates advocating complete government-run care are Ohio Rep. Dennis Kucinich, who calls for an end to private insurance and “Medicare for all,” and former Sen. Mike Gravel, who calls for equal medical care provided through health care vouchers.

Giuliani’s central argument is that if the Democrats have their way, the public’s health is in danger. As we’ve noted, that’s simply not supported by the bogus statistic he gives as evidence. There is, however, ample evidence that lack of health insurance is hazardous to an individual’s health, and that those who do have coverage (as Giuliani did as mayor) live longer.

When it comes to prostate cancer specifically, a 2003 study of cancer patients in Kentucky, published by the American Medical Association’s Archives of Internal Medicine found: “Among patients with prostate cancer, 3-year relative survival proportion was 98% for the privately insured and 83% for the uninsured.”

The study found similar disparities for breast cancer, lung cancer and colorectal cancers. For each type of cancer, those without insurance were more likely to die sooner. The study looked at 35,855 cancer patients in the state, including 6,959 men with prostate cancer.

The authors noted that earlier studies established that cancer patients who lack health insurance tend to be diagnosed later in the course of their disease, and also to receive different treatment, than those who have coverage. Similarly, a 2002 report by the National Academies’ Institute of Medicine examined 130 research studies and found that “working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital.”

Conclusion

With the wealth of research available, Giuliani may well find other evidence to support his opposition to expanded federal health insurance programs. Indeed, when we challenged his bogus prostate-cancer figures, his campaign sent us links to a study by Lancet Oncology that found better cancer survival rates in the U.S. compared to Europe overall. But that’s no excuse for feeding a false statistic to the public.